I have been seen by two doctors. Both say I have glaucoma. I would like to know what the devil this is because both doctors said to use Xalatan at bedtime for the rest of my life.

DEAR READER: Glaucoma is a group of diseases that damage the optic nerve in the eye(s) that results in diminished vision, leading to blindness. The light-sensitive optic nerve connects the retina to the brain, transmitting visual information.

There are different forms of the disorder, but the most common is known as open-angle glaucoma. The front of the eye has a space known as the anterior chamber, through which a clear fluid flows, nourishing surrounding tissues. The fluid leaves the anterior chamber and flows through a drain area and leaves the eye. There are times, however, when it passes too slowly through this drain, resulting in a buildup of fluid. The buildup of pressure that results can damage the optic nerve, resulting in open-angle glaucoma and may lead to a loss of vision. It should be noted that an increase in eye pressure is not an indication a person has glaucoma. Rather, it indicates a person is at risk for glaucoma. Then there is the diagnosis of glaucoma without an increase in pressure. This is slightly less common but is known as low or normal-tension glaucoma. Some people are able to withstand higher eye pressure than others. It all depends on how much pressure your optic nerve can handle.

The key is early detection. Eye exams should be performed by an ophthalmologist or optometrist every three to four years for Caucasians and two to four years for African-Americans aged 20 to 39, every two to four years for both races aged 40 to 64, and every one to two years for both races aged 65 and older. Under ordinary circumstances, if a person follows these timelines, visual abnormalities can be corrected and treated early. If glaucoma is discovered, medication in the form of eyedrops or pills can be prescribed to either lower the pressure or cause the eye to make less fluid. It may be necessary to take the prescribed medication several times a day. If you experience burning, stinging or redness, advise your prescribing specialist, who can make a modification.

It is important to understand that glaucoma often has no symptoms, and you may be inclined to discontinue your medication. Continued use is extremely important. The purpose of the medication is to either lower the production of fluid or to reduce the pressure of the fluid.

The Xalatan drops you have been prescribed will reduce the pressure in your eye(s). You should wash your hands before and after use. The medication should be taken in the evening unless your doctor provides other instructions. You may experience blurred vision, and your eyes may become sensitive to light. Refrain from driving or doing detailed work until you determine whether you experience any unwanted side effects. Never use more than the recommended dose.

It appears both physicians you consulted are in agreement. My guess is the Xalatan is a completely appropriate recommendation that you should follow. Many people your age are on more medications every day than I have fingers and toes. You’re one of the fortunate ones that have reached the age of 78 without a plethora of problems.

To provide related information, I am sending you a copy of my Health Report “Medical Specialists.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Even today, Timoptic is contraindicated for patients with a history of chronic bronchitis, emphysema, bronchial asthma, chronic obstructive pulmonary disease and a number of cardiac conditions. I cannot tie in your shortness of breath 20 years following usage, but I wonder whether you had an existing condition even then that might have been exacerbated by the medication. This can best be determined by a pulmonologist, who will listen to your lungs, and perhaps order a chest X-ray, CT or MRI to determine just what is and isn’t going on.

I am unaware of a link to urinary difficulties with Timoptic but can offer some other possible causes for the condition. Retention can be caused by an obstruction in the urinary tract or by mixed signals between the bladder and the brain. Diabetes, pelvic injury, vaginal childbirth, bladder stones and infection of the spinal cord are but a few more options. An infection can cause inflammation and irritation, resulting in urinary retention.

A cystocele can result when the wall between the bladder and the vagina weakens, allowing the bladder to sag into the vagina. A rectocele occurs when the rectum sags into the back wall of the vagina. Both conditions can force the bladder out of position, causing incontinence and retention.

I feel you need a referral to an urologist for a complete examination to rule out specific conditions, while allowing concentration on others. Unless your specialist discovers something unexpected, the issue may be controlled completely by medication. Should surgical correction be necessary, you can then discuss the pros and cons of such a procedure to determine whether it is appropriate for you. Also, he or she might have an idea whether the Timoptic may have caused the condition, or whether other circumstances came into play at the same time as your breathing difficulties.

To provide related information, I am sending you copies of my Health Reports “Pulmonary Disease” and “Vaginal Infections and Disorders.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.

Several years ago my doctor diagnosed me with glaucoma and prescribed Timolol to control the pressure.

Please tell me that this statement was a misprint or a mistake.

DEAR READER:
I made a mistake for which I apologize. Thank you for bringing this to my attention.

Timolol is a glaucoma medication used to reduce intraocular pressure. It can cause depression, cold hands and feet, cardiac arrhythmias and nightmares, but is rarely related to eye problems. However, it can be associated with glaucomatous cupping which is the formation of an ocular disk depression seen in some cases of glaucoma.

Could you tell me if there is any treatment for this condition? My doctor didn’t tell me if anything could be done. Should I get a second opinion?

DEAR READER:
Let me start by saying that if you don’t ask questions, your doctor can’t answer them. If there were something you didn’t understand or simply wanted to know more about, you should have stated that. Doctors aren’t mind readers. Unless the patient says otherwise, the physician assumes the information has been understood. I have said time and again that people who take active roles in their health will usually get the best care.

Now to your problem. Pigment is the substance that gives our eyes color. Sometimes this pigment can flake off and land on other places, such as the lens. Often it goes unnoticed as it doesn’t cause symptoms.

I believe what your ophthalmologist was referring to a rare form of glaucoma called pigmentary glaucoma. This condition results when pigment flakes off the iris and blocks the meshwork that allows for proper drainage within the eye. This increases the intraocular pressure leading to damage to the optic nerve, better known as glaucoma.

If your eye pressures had been increased, you likely would have been told so and given steps or medications to take to reduce the pressure and prevent further damage. In your case if the pigment is only on the lens, it is probably not blocking the meshwork. I recommend you return to your ophthalmologist and ask for further clarification of the situation. If he or she refuses to elaborate, get a referral for a second opinion.

In investigating, I realized glaucoma was sort of like a stroke of the eyes so I decided to test the drink. It tasted delightful and better still, within minutes my partial vision cleared and I was able to read again. A few weeks later my vision worsened so I drank another glass and my vision cleared.

I have since tried altering the drink a bit. I have eliminated the sugar and reduced the coffee to only one cup (but left the instant coffee at one heaping tablespoon). I only drink it when my vision starts to get foggy or I feel uneasy about my eyes and my vision clears. I have only used the drink four times in 10 weeks.

I know this remedy sounds far fetched by since first starting this; I have been seen by two doctors at two clinics within two days of each other. Both times, my eye pressures had dropped to normal and appeared to be holding. I don’t know if this will work for others but it certainly works for me so I hope you will print my letter to share with your readers.

DEAR READER:
Glaucoma is a complex disorder that can cause damage to the optic nerve, resulting in loss of vision and blindness. I must take a moment to state that not all increased eye pressure carries a diagnosis of glaucoma. In fact, glaucoma can develop with normal pressure readings on testing. The optic nerve must be damaged for the condition to occur. Beyond that, individuals vary in their ability to tolerate increased levels, so there is no definitive value for diagnosis.

You do not indicate if you are on any medication. I can only determine you are under the care of an ophthalmologist who has you on drops or pills for control. Should this be the case, you must take your drugs precisely as instructed by your eye care professional. Several of the medications must be taken more than once a day to be completely effective. Side effects from drops can include burning and redness. If you discontinue taking your drops or pills on occasion for this or other reasons, return to your prescribing physician who will be able to switch you to another comparable medication with fewer side effects.

From a medical standpoint, I must agree your remedy is quite far fetched. However, there are possible reasons for the pressure to decrease and your vision to improve. Symptoms can improve when you are in a relaxed stated, such as when you have had a cocktail. Adversely, they can exacerbate in times of increased stress. I suggest you experiment by listening to calming music, walking around the block, or by doing something else that truly relaxes you. If you have positive results, we have the answer.

To give you related information, I am sending you a copy of my Health Report “Medical Specialists”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.